Experience with dacron graft arteriovenous fistulas for dialysis access

The technique, hemodynamics, and results of a new, more successful Filamentous Velour Dacron graft dialysis fistula between brachial artery and axillary vein are described. Hemodialysis has been successfully instituted in 15/16 patients. One graft was removed for infection and one for overlying skin erosion. There have been five episodes of thrombosis, all with successful restoration to function. After a median nine-month follow-up, nine of 16 grafts have been complication-free and 13 of 16 remain functional or functioned until the time of death. Hemodynamic studies revealed that with high flows (even 1900 cc/min), there was no evidence of cardiac failure or peripheral "steal". One patient with low flow (less than 300 cc/min) had transient distal ischemic symptoms and another with similar flow later developed arterial occlusion distal to the fistula after suffering a myocardial infarction. With increased attention to technical details observed in this early experience, it appears that greater than 80% of these grafts should provide long-term dialysis access for this difficult patient population.